The aim of this study was to determine the similarities and differences in the frequency and follow-ups of newly diagnosed atopic diseases after liver transplantation in pediatric and adult patients.Patients who underwent liver transplants between 2005 and 2013 and who are still alive were enrolled in the study. Patients who came for checkups filled out a survey evaluating atopic diseases. Those who had an atopic disease before transplantation were excluded from the study.A total of 165 patients were enrolled in this study; 114 (69.1%) were males and 29 (17.6%) were children. The average transplantation age was 40.8 (0.3-67) years, and the most frequent reason for transplantation was chronic viral hepatitis. In 22 patients, atopic diseases [allergic rhinitis in nine patients (5.5%), asthma in six patients (3.9%), atopic eczema in six patients (3.9%), food allergy in six patients (3.9%), and drug allergy in one patient (0.6%)] developed after transplantation. Atopic diseases after transplantation were more common in children (P=0.03). When the atopic diseases were examined on a case-by-case basis, there were no differences between children and adults with respect to asthma (P=0.284), allergic rhinitis (P=1.0), or atopic eczema (P=0.284), but food allergy (P=0.009) and peripheral eosinophilia (P=0.002) were more common in children. The periodicity of allergic diseases after transplantation (P=0.192) and total IgE levels (P=0.086) were similar.Atopic diseases developed after liver transplantation and had a greater impact on children than adults. Therefore, after undergoing liver transplantation, patients should be monitored closely for signs of atopic diseases.
Food protein-induced enterocolitis syndrome (FPIES) is an under-recognized and frequently misdiagnosed non-IgE-mediated gastrointestinal food hypersensitivity disorder. We describe the first case of FPIES only to wheat confirmed by an oral food challenge (OFC). The male patient, who was breast fed for the first 2 months, and then was feeding with cow's milk-based formula until he became 4.5 months old, was given a tarhana soup (wheat and yoghurt) for the initial food trial. Two hours later, he started retching and vomited consecutively, suffering from watery diarrhea. He was taken to a medical center, where he was diagnosed acute gastroenteritis. He suffered from three more episodes after feeding wheat-containing foods. When the patient was 12 months old, an OFC with wheat was performed. Two hours after he had been challenged, he vomited repetitively, became lethargic, his systolic blood pressure dropped from 95 to 80 mm Hg and stool examination revealed eosinophils and leukocytes, which were negative before the challenge. The serum eosinophil count decreased from 460 to 270 μL and the neutrophil count increased from 2,200 to 10,500 μL at 6 h. The skin prick test with wheat extract, prick to prick test with whole wheat and serum-specific Ig E for wheat were negative. We conclude that FPIES can emerge with food in connection with eating habits or culture. In view of its potentially serious clinical course, it is critical to consider this diagnosis in young children presenting with acute onset of gastrointestinal symptoms or shock.
Background. Inadequate practices in diagnosis and management of anaphylaxis in parallel with an increase in its prevalence may cause serious public health problems today. This is the first study aiming to assess the theoretical knowledge of professional and non-professional healthcare workers from different lines of the healthcare service chain about anaphylaxis management, and their practice approaches for epinephrine autoinjectors (EAIs) together. Methods. The study included 697 participants comprising physicians, dentists, pharmacists, and school staff. In face-to-face interviews, each participant was asked to fill out the questionnaire forms prepared for assessing their demographic characteristics, experience with a case of anaphylaxis and EAI and theoretical knowledge about the diagnosis and treatment of anaphylaxis, and to demonstrate how to use EAI in practice with trainer device. Results. The rates of 391 physicians, 98 dentists, 102 pharmacists and 105 school staff of knowing the diagnosis criteria of anaphylaxis were 47.6%, 31.6%, 31.1%, 19%, and knowing the first and life-saving treatment of anaphylaxis were 87.2%, 79.6%, 47.6%, 15.2%, respectively. Predictors that affected physicians in knowing the first and life-saving treatment of anaphylaxis were having experience with EAIs [OR:5.5, (%95CI:1.330-23.351, p=0.015)] and a case of anaphylaxis [OR:2.4, (%95CI:1.442-4.020, p=0.001)], and knowing the administration route of epinephrine correctly [OR:1.9, (%95CI:1.191-3.314, p=0.008)]. 31.1% of the participants demonstrated the EAI usage correctly. The EAI usage steps with the most errors were `Place the appropriate injection tip into outer thigh/Press the trigger so it `clicks`` and `Turn the trigger to arrow direction` (60.3% and 34.9%, respectively). Conclusions. Healthcare workers` knowledge level regarding anaphylaxis management and ability to use EAIs correctly are not adequate. That most errors were made in the same steps of EAI usage indicates that the industry should continue to strive for developing the ideal life-saving device.
Food allergy has been increasingly reported in children who had orthotopic liver transplantation. The exact mechanism of post-liver transplantation allergies remains to be elucidated. Children are at risk for the development of food allergy for the first year of transplantation and immunosuppression with tacrolimustreated patients. 11-month-old patient that underwent transplantation of liver at the month of 5 due to giant cell hepatitis, consulted to our pediatric emergency department after 15 minutes with body itching, redness, swelling of the lips, and rapid breathing, cough after 10 minutes of eating egg. The patient was diagnosed as anaphylaxis, and then injected epinephrine intramusculer. After 4 weeks, the patient whose clinical findings improved, 5 x 5 mm induration (negative control 0 mm, positive control, 6 x 6 mm) of white egg were detected in the skin prick test. Our aim of presenting this fact is to emphasize the necessity to closely monitor the patients especially in the age group of infants with hepatic transplant for the development of food allergies.
Oz (Ingilizce):Objective: The diagnostic gold standard of food allergy is the oral food challenge. Oral food challenge may induce allergic reactions, ranging from mild cutaneous symptoms to severe, potentially life-threatening reaction. Our aim was to investigate the prevalence and severity of reactions during oral food challenge. Materials and Methods: A retrospective charts review of children undergoing oral food challenge at the our Allergy Clinic between September 2012 and September 2013 was performed. Results: A total of 63 oral food challenges were included the study. Most frequently involved foods were cow's milk, pistachio nut and egg. Oral food challenge were carried out to confirm the diagnosis in 50 (79.4%) patients and were carried out to demonstrate the development of food tolerance in 13 (20.6%). 13/63 (20.6%) were positive. Twelve patients were defined mild reactions and one patient was anaphylaxis. There were no significant differences between the oral food challenge negative group and oral food challenge positive group in terms of sex, age at the time of oral food challenge, concomitant atopic disease, history of IgE mediated food allergy, peripheral eosinophils per cent, serum specific gE and total IgE (p> 0.05). But there was a positive correlation between the size of skin prick test and oral food challenge positivity (rho: 0.307, p= 0.019). Conclusion: The majority of reactions during oral food challenge were mild. The size of skin prick test was the risk factor for the development of reaction during oral food challenge. Therefore, oral food challenge should be done by the experts and size of skin prick test should be taken into consideration before oral food challenge.
Background: Cystic Fibrosis Registry of Turkey shows various CFTR mutations due to the geographical location and historical background of our country, and also high prevalence of consanguineous marriages. Method:All mutations detected in the Cystic Fibrosis Registry of Turkey 2017 (CFRT2017) data were screened in CFTR1 and CFTR2 databases. Mutations which were not found in both were identified and characteristics of these patients were compared with F508del homozygous patients. Results: Among 1170 registered patients, 978 were genotyped and 200 different mutations were shown in 1270 alleles.29 mutations were not reported in both databases; 58 mutations have been reported in CFTR1 but not in CFTR2. Demographic and phenotypic characteristics of the 112 patients with 87 different alleles those were not previously reported in the CFTR2 database (nonCFTR2 group) were compared with F508del homozygous 103 patients in CFRT2017. In the nonCFTR2 group, mean age was younger (5.81 vs 7.69; p:0.015), mean age at diagnosis was older (1.88 vs 1.08; p:0.041), sweat test was lower (75.12 vs 98.28; p<0.001), number of patients with chronic Pseudomonas aeruginosa colonisation was lower (17.9% vs 31.1%, p:0.041), number of patients with chronic Staphylococcus aureus colonisation was also lower (17.9% vs 34.0%; p:0.015) and CF related complications, eg. CF related diabetes was detected in fewer patients (1.8% vs 10.7%; p:0.002). Conclusion: We suggest that patients in the nonCFTR2 group have a mild clinical course, but in some patients, further investigations and functional studies are required for the exact diagnosis.
Background: Allergic rhinitis (AR) is a chronic disease that is becoming increasingly common worldwide and has a negative impact on school performance, work performance, and quality of life. The aim of this study was to investigate the effect of vitamin D on the symptoms of AR in children. Methods: Serum vitamin D levels of children with AR and age-matched healthy controls were compared using the high-pressure liquid chromatography method. The relationship between serum vitamin D levels and symptoms and severity of AR was then examined. Results: The study included 137 patients diagnosed with AR (76 males, 61 females; median age: 11 years). Serum vitamin D levels were lower in the patient group than in the control group (P = 0.001), lower in all aeroallergen groups (mites, pollen, and multiple inhalants) than in the healthy control group (P = 0.001), and lower in both the perennial AR group and the seasonal AR group than in the control group (P = 0.001). Spearman correlation analysis showed that there was no correlation between symptom score and vitamin D level (rs = -0.099; P = 0.25). Conclusions: We found no correlation between serum vitamin D level and symptoms and severity of AR. Serum vitamin D levels were lower in children with AR than in healthy children.
